The removal of the patella by surgery is referred to as a patellectomy (knee cap). One type of patellectomy involves the removal of the entire patella, while another type involves the removal of only a portion of the kneecap. The patella, often known as the kneecap, is a tiny, movable sesamoid bone found near the front of the knee.
The patella is inserted in the quadriceps tendon, which binds the thigh muscle to the tibia just below the knee. The patella works as a pulley for the quadriceps, increasing power during knee motions. Some conditions call for surgical removal of the patella, including severe knee osteoarthritis, anterior knee discomfort, and comminuted (shattered) fractures.
Even though there are now fewer circumstances that call for a patellectomy, it is nevertheless advised as a last resort in cases of the following conditions:
- Comminuted Fractures.
- Advanced Osteoarthritis or Chondromalacia.
- Tumoral Disorders.
In the case notes, it is always clear why a patellar resection is being done, but sometimes there is not enough information about the preoperative conditions. The most common presenting symptom (one patient who underwent surgery on both sides) is discomfort, both during and after activity. In a small number of cases, severe mobility restriction and/or contracture are the primary indicators, while in other cases, instability and/or a propensity for patellar dislocation are the predominant indicators.
In most cases, the procedure is carried out in a sterile operating room by making a transverse incision in the patient’s skin, a longitudinal cut in the tendon, and a precise dissection of the patella. In certain instances, a parapatellar incision is also performed. The tendon defect is generally closed with sutures, but occasionally a fascia graft is necessary that’s because the defect is frequently too large.
Patients who undergo a patellectomy, which needs an incision, are subject to the usual dangers associated with undergoing surgery, including the following:
- Delayed recovery
To reduce the aforementioned dangers, patients are advised to adhere to pre-and post-operative instructions with great care.
In addition, a patellectomy is associated with several long-term and severe knee conditions, including:
Weak knee extension: This condition develops when the loss of the patella causes the quadriceps muscles to lose their normal effectiveness. It is difficult for the patient to straighten his leg as a result of this.
Abnormal laxity: Since the patella plays a crucial role in knee movement, its removal causes the quadriceps tendons to become more lax than usual.
Risk of Femoral Joint Damage: Damage to the femoral joint is possible even with very mild falls because the patella acts as a protective shield for the femoral joint.
The hazards of a patellectomy outweigh the advantages because some of the aforementioned symptoms are long-lasting.
Recently, certain studies and innovations are being performed to lessen the procedure’s long-term dangers. Among these are newly developed resurfacing treatments, such as replacing the trochlea with a metal item to provide greater stability after a patellectomy. However, a patellectomy is still only carried out when all other possibilities are done to guarantee the long-term security and stability of patients’ knees.
There are two different kinds of patellectomy: total, in which the patient’s kneecap is removed in its entirety, and partial.
Patients are provided with comprehensive pre-operative instructions to assure both their safety and the efficacy of the procedure they are about to undergo. First of all, they are instructed to stop using all anti-inflammatory drugs at least a week before surgery because their influence on blood thinning often results in increased bleeding. Additionally, they are often required to complete a pre-operative test a few days before surgery.
On the day of the surgery, the patient lies down on the operating table and is given general anesthesia. After that, the surgeon makes a straight cut in the tendon to provide access to the patella bone. The bone is removed in whole or in part, depending on the treatment being done (partial or total). Although the tendon is left whole and fully functional after the treatment, some of its long-term implications on the overall functionality of the knee made it a problematic medical practice.
After a patellectomy, a thorough physiotherapy regimen is essential. In the first few weeks following patellectomy surgery, a physiotherapy programme focuses on helping the patient maintain mobility, minimising pain and swelling, improving stability and range of motion, and strengthening the muscles around the knee. Patients recovering from a patellectomy are advised to engage in regular physical therapy sessions. The physiotherapy primarily entails:
- Hip stretches.
- Scar massage.
- Strengthening and Stretching calf muscles.
- Stretching and Strengthening of hamstrings.
- Quadriceps Strengthening and Stretching.
- Ankle Stretches.
- Exercises not involving weights.
- Ice Therapy.